Intravenous Immunoglobulin-Associated Hemolytic Anemia

Intravenous immunoglobulin (IVIG) is an important therapeutic tool for the treatment of a variety of conditions, including immune thrombocytopenic purpura (ITP). Although IVIG has many approved indications and is typically well tolerated, a number of adverse effects have been reported. Hemolysis is a documented but under-recognized adverse effect associated with large individual or cumulative doses of IVIG. Hemolytic complications are typically mild and detected incidentally when screening tests, such as a complete blood count (CBC) showing decreased hemoglobin or a complete metabolic panel (CMP) resulting in elevated bilirubin, are performed for another reason. Herein, we report a case of significant hemolytic anemia in a 59 year old Caucasian woman, who required packed red blood cell transfusion after administration of IVIG for the treatment of ITP. Increased awareness of the potential for clinically significant hemolysis after the use of moderate cumulative doses of IVIG is needed, particularly in patients with risk factors for hemolysis.